Childhood Neuroblastoma Survivors at Risk for Cognitive Impairment

Survivors of pediatric neuroblastoma may face cognitive difficulties years down the line, even if their treatment occurred before age 1, explained Caroline Hesko, MD, MPH, a pediatric hematology/oncology fellow at the University of Chicago Comer Children’s Hospital.

“Even those patients who were younger than a year—who we think of as not getting a lot of treatment—were still at risk for a lot of these impairments,” Hesko said in an interview with Oncology Nursing News^®. “So be aware that even patients who you think are at low risk may still be having issues later on in life.”

Childhood Cancer Survivor Study

Hesko and her team analyzed data from the Childhood Cancer Survivor Study (CCSS), which is a large database of childhood cancer data pooled from more than 30 institutions across the United States from 1970 to 1999. The study included participants who had received a diagnosis before age 21 and closest age-matched siblings as controls. Genetic and genomic data were also included. Specifically, Hesko’s research examined the cohort of patients with neuroblastoma.

Using a neurocognitive questionnaire, the researchers analyzed 4 domains: task efficiency, organizations, emotional regulation, and memory. A total of 837 neuroblastoma survivors were analyzed. Survivors were divided into 2 groups: those who were diagnosed and treated before age 1 and those who were older than 1.

Survivors’ outcomes were compared against their age-matched siblings. Depending on their age of diagnosis and the type of therapy they received, survivors were found to be at different levels of risk.

Survivors at Risk

“We specifically found that survivors were at an almost 80% risk of impairment in task efficiency. When we think of task efficiency, we think of processing speed and how fast someone is able to do a task,” Hesko said. “Those impairments not only depend on age, but also the types of therapies they got. We found that patients who were exposed to platinum-based chemotherapy agents were at higher risk for impairment.”

Survivors were at a 50% higher risk of task efficiency impairment and emotional regulation compared with the sibling controls. Among patients who were 1 years old or younger, there was a higher risk of impairment for those who were treated with platinum chemotherapy, had hearing loss associated with treatment, and neurologic conditions.

“Especially when it comes to platinum exposure, linked to that is also hearing loss that can go with, and those patients are at higher risk for impairments,” Hesko said. “Knowing that [we should have] patients and families be on the lookout for [signs of impairments] and be proactive about getting help.”

Help Is Possible

The good news is that if patients, families, and their care teams notice the signs of cognitive impairments, there are interventions that can help.

“For example, if a young student is having issues with organization or processing speed, it may just be that they need a different way of organizing their work to be able to help them to succeed. Similarly, knowing if [a survivor] struggles in these areas, figuring out what type of job may be best will help [them] to make an informed decision on how to move forward,” Hesko said.

Moving forward, clinicians should be cognizant of the signs and risks of cognitive impairment and discuss them with patients and their families, Hesko explained. If families know that their child’s cognitive impairment could be a result of their cancer treatment, they can better seek support to help them succeed.

“The hope is that they’ll be able to get the help that they need, especially when it comes to things like school allowances, as well as insurance companies being able to get therapies that may help them,” Hesko said.